Interventional Endoscopic Ultrasound (EUS) | October 2026-ABIMANSOUR

ABIMANSOUR_ASGE iEUS Ablation

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The presentation reviews endoscopic ultrasound (EUS)-guided ablation of pancreatic cysts and tumors, an emerging organ-preserving and locoregional treatment approach. Potential candidates include selected pancreatic neuroendocrine tumors (PNETs), locally advanced pancreatic ductal adenocarcinoma (PDAC), pancreatic metastases—particularly from renal cell carcinoma—and moderate- to high-risk mucinous cysts.<br /><br />For insulinomas, a propensity-matched retrospective study found EUS radiofrequency ablation (RFA) had shorter hospital stays and fewer adverse events than surgery, with 95.5% clinical efficacy. However, relapse was more frequent after RFA (16.9% versus none after surgery), highlighting the need to weigh reduced treatment burden against durability.<br /><br />PDAC ablation has a proposed immune-stimulating effect, but clinical evidence remains exploratory. Small studies report possible survival or tumor-response benefits when RFA is combined with chemotherapy, radiation, or immunotherapy. Ablation may be considered for selected patients with residual or recurrent disease after maximal treatment; it is not established standard care.<br /><br />Cyst ablation may suit branch-duct IPMNs around 3 cm or larger with high-risk or worrisome features, when malignancy is not evident and treatment is technically feasible. Chemoablation and RFA studies report cyst responses, but there are no randomized trials or demonstrated survival benefit, and risk-benefit judgments rely on limited data.<br /><br />Techniques include ethanol injection, RFA, and chemoablation. RFA uses an EUS-guided electrode to generate heat and coagulation necrosis; treatment depends on power, duration, tissue conductivity, and probe size. Cyst RFA generally requires greater energy delivery. Chemoablation involves aspirating the cyst and instilling gemcitabine–paclitaxel, sometimes repeated after three months.<br /><br />The presentation emphasizes multidisciplinary referrals from oncology, surgery, endocrinology, urology, and gastroenterology. Careful candidate selection, technical expertise, and frank discussion of uncertain benefits and risks are essential.

Keywords

endoscopic ultrasound

EUS-guided ablation

pancreatic cysts

pancreatic tumors

radiofrequency ablation

pancreatic neuroendocrine tumors

pancreatic ductal adenocarcinoma

insulinoma

chemoablation

multidisciplinary referral